Provider Demographics
NPI:1346380128
Name:VILLALUZ, LUCILA QUINTO (MD)
Entity Type:Individual
Prefix:
First Name:LUCILA
Middle Name:QUINTO
Last Name:VILLALUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5349
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-0349
Mailing Address - Country:US
Mailing Address - Phone:484-221-9136
Mailing Address - Fax:484-221-9130
Practice Address - Street 1:865 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1935
Practice Address - Country:US
Practice Address - Phone:670-691-4357
Practice Address - Fax:484-221-9130
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055156-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018606OtherAMERIHEALTH 65 COMPLETE
PAG80233OtherMAGELLAN BEHAVIORAL HEALT
PA018606OtherGATEWAY 65 COMPLETE
PA001621278Medicaid
PA001621278Medicaid
PA018606OtherAMERIHEALTH 65 COMPLETE